Clearinghouses and banks are a vital part of your practice, as they help simplify the medical billing process for your administrative team. Using a clearinghouse improves your ability to submit clean claims and reduce overall denials. Submitting clean, accurate claims shortens your revenue cycle and enhances the patient experience.
However, using a clearinghouse solution is not without risk. Because these organizations handle a large amount of confidential data, they are prime targets for cybercriminals. Fortunately, your practice and your medical billing partner can reduce these risks by using multiple clearinghouses.
What is a Clearinghouse?
In medical billing, a clearinghouse serves as a go-between for you and the insurance company. Whether you’re handling medical billing in-house or working with a partner, you would use a clearinghouse to check your claims for errors, verify coverage, and submit your claims once they’re clean.
A clearinghouse can also transfer information from various forms into standard data before sending the claim so the insurance company can quickly process and pay the claim. Medical billing is complex and uses multiple sets and codes. Variations in coding and processing can cause frequent errors, which impact your revenue cycle. Using a clearinghouse speeds up the scrubbing process.
How Clearinghouses Benefit Healthcare Organizations
In addition to scrubbing and submitting claims, clearinghouses automate payments to medical practices. They use software to reconcile payments with their respective claims to help you get paid faster.
Clearinghouses can also analyze your claim data and identify common causes for denial. They can also generate invoices and give patients options to pay online, which improves your chances of receiving payment.
The Recent Cyberattack
In February 2024, Change Healthcare, a clearinghouse in the United States, was hit by a ransomware attack and was forced to take its systems offline to fix the problem. Clinicians and healthcare organizations were unable to bill, manage, and issue prescriptions. Pharmacies could not fill prescriptions, and insurance companies encountered difficulties in paying claims.
Because of this attack, many organizations could not get paid. For a smaller practice with less cash flow than larger businesses, these types of incidents can cause financial distress. Healthcare organizations impacted by the Change cyberattack stated that they amassed thousands of dollars in overdue payments during the weeks the Change system was offline, according to Reuters.
Even with security protocols in place, any business can experience a cyberattack. The majority of cybersecurity professionals have seen an uptick in these crimes in the past year, with cybercriminals diversifying their tactics to gain access to computer systems. Healthcare professionals and associated businesses are a lucrative target for people wanting access to personal data.
How Multiple Clearinghouses Can Help
Working with multiple clearinghouses helps you mitigate risks associated with system outages. If one of your clearinghouses has to take its system down due to a cyberattack, a natural disaster, or any other reason, you have a backup method for cleaning and submitting claims.
There are different types of clearinghouses for various claims. Your medical billing partner may use one clearinghouse for pharmacy claims, another for in-patient claims, and a third for outpatient claims. Each of these clearinghouses understands the complexities associated with coding and billing for services and submits the claims in a HIPAA-compliant format.
Your medical billing partner may also use multiple clearinghouses for similar services rather than sorting claims by type. This way, if one clearinghouse is backlogged, they can submit claims through another clearinghouse to get them processed faster.
When you’re evaluating several clearinghouses, don’t sacrifice quality. If you’re using a clearinghouse, consider your current satisfaction level. Examine your revenue cycles and claim denial rates. Look for weaknesses in your current processes. As you start shopping around for multiple clearinghouses, determine which of these issues you may be able to fix by switching providers.
How to Choose a Clearinghouse
If you’re interested in using a clearinghouse, consider these features:
- Ease of use: Assess how easy the clearinghouse is to work with in terms of dashboards and data entry.
- Customer service: Look for a clearinghouse that offers 24/7 customer service and quickly responds to issues.
- Claims mix: Choose a clearinghouse that connects with your regular payers. Assess their reach and scope and all the services they offer.
- Error rates: The point of using a clearinghouse is to make it easier to submit and process claims. Evaluate the clearinghouse’s error rate to make sure they are actually simplifying your billing process.
- Turnaround times: Health insurance providers must send certain forms with payments, including an explanation of benefits. Make sure the clearinghouse will send them promptly and not charge you extra.
- Customer reviews: Look for current customer reviews and note the pros and cons of each company.
Keep Your Data Safe
Your medical practice may also be at risk of a cyberattack. Take these steps to keep your systems safe from ransomware and other cyberattacks:
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Encrypt patient data: Protect patient data by encrypting it. This adds a layer of protection from cyberattacks, as anyone who stole the data would have to decrypt it.
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Authenticate users: Control permissions on who can access patient data and put in multi-factor authentication tools to keep unauthorized people from accessing it.
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Secure IoT devices: More healthcare organizations are using internet-connected devices, such as connected medical monitors, to care for patients. Use encryption and digital signatures to protect them from cybercriminals.
Partner with PUREDI
When outsourcing medical billing, it’s important to choose an experienced partner. PUREDI’s medical billing software and services were developed by a team of billing and coding experts who understand your needs.
Our services offers reporting tools and other features that give you valuable insights into your billing practices. We also work with multiple clearinghouses when offering medical billing services. In case of a security breach or another type of emergency, we are here to work with you in restoring your practice to normal operations.
Schedule a demo today to learn more.
